| NPI | 1720741440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 253Z00000X In Home Supportive Care |
| Additional Taxonomies | 133NN1002X Nutritionist, Nutrition, Education |
| 225100000X Physical Therapist | |
| 2255A2300X Specialist/Technologist, Athletic Trainer | |
| 226300000X Kinesiotherapist | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| Enumeration Date | 2021-10-19 |
| Last Update Date | 2021-10-19 |